Hydration status in older adult patients and the relationship to factors affecting the access and intake of fluid : a thesis presented in partial fulfillment of the requirements for the degree of Masters of Science in Nutrition and Dietetics at Massey University

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Massey University
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Objectives: To assess fluid intake and access among hospitalised patients ≥65 or ≥55 years and to compare total fluid intake with the patient’s hydration status as determined by serum osmolality. Methods: Eligible patients, aged were recruited from Northshore and Waitakere hospitals within the Waitemata DHB in NZ. Socio-­‐demographic characteristics were collected using an electronic questionnaire. The patients’ fluid intake was measured using the interactive FIAT, which enabled patients to select any beverage or high fluid food (e.g. jelly, custard, soup) that they had consumed from the hospital, onsite cafeteria, and vending machines. The patients were able to indicate how much they had consumed using a visual representation of the product filled at various volumes for guidance. The patients’ access to fluid and potential barriers to them meeting their fluid requirements was assessed using the FAST on an electronic device. Serum osmolality, sodium, potassium, haematocrit and creatinine were determined as indicators of hydration status and collected within 24 hours of the FIAT and FAST. Results: The study sample (n=54) included 23 (43%) men and 31 (57% women) with a mean age of 82.5±8.10 years. The FIAT identified that the majority of patients did not meet their fluid recommendations (n=46, 90%) and that half (n=27) had a low fluid intake of less than 1.6L/day. The FAST identified that of those patients with low fluid intake 16 (59%) struggled to open fluid containers and 10 (37%) sought assistance with opening. Patients who struggled to open fluids had a higher mean serum osmolality than those who didn’t struggle (297±6.88mOsm/kg versus 291±7.80mOsm/kg, P=0.009). Half of the patients were impending dehydration (n=15, 33%) or were dehydrated (n=9, 20%). Conclusions: Low fluid intake appeared to contribute to dehydration. Early assessment of fluid intake and hydration status is critical to prevent dehydration in older hospitalised patients. It is recommended that health care staff ensure all patients are able to open the provided fluids. Adequate hydration status may aid in the patients recovery, reducing their length of stay and thus the cost of their treatment.
Dehydration (Physiology), Older people, Hospital patients, Nutrition, New Zealand, fluid intake, hospitalised older adults, serum osmolality